ISSN: 2378-3176 UNOAJ

Urology & Nephrology Open Access Journal
Research Article
Volume 2 Issue 4 - 2015
Quality of Life in Hepatitis C Virus Seropositive Hemodialysis Patients
Waleed Anwar, Haitham Ezzat* and Amr Mohab
Department of Internal Medicine, Ain Shams University, Egypt
Received: March 24, 2015 | Published: August 14, 2015
*Corresponding author: Haitham Ezzat, Nephrology Division, Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt, Tel: 00201006499550; Email:
Citation: Anwar W, Ezzat H, Mohab A (2015) AQuality of Life in Hepatitis C Virus Seropositive Hemodialysis Patients. Urol Nephrol Open Access J 2(4): 00048. DOI: 10.15406/unoaj.2015.02.00048

Abstract

Background:Health-related quality of life (HRQOL) is a multidimensional concept that reflects a patient’s perceived well-being. It was well demonstrated that HCV had a negative impact on (HRQOL). The aim of this study was to assess HRQOL in hepatitis C Virus (HCV) seropositive hemodialysis Egyptian patients and highlight possible factors affecting it.
Patients and methods:200 ESRD patients on regular hemodialysis at Ain Shams University hospitals and National Institute of Nephrology and Urology were included in this study and divided into 2 equal groups of HCV Ab seronegative and seropositive. Both groups were subjected to full medical history taking and examination. Laboratory investigations included hemoglobin level, pre dialysis blood urea, creatinine, calcium, phosphorus, PTH, ALT, AST, albumin and viral markers. Dialysis adequacy using Kt/v. HRQOL was measured through Short Form 36 (SF-36). In each dimension the respondent receives a score from 0 to 100. The higher the score, the better the health.
Results:Our study showed that HCV seropositive hemodialysis patients had compromised HRQOL in comparison to HCV seronegative patients which was found in most of SF-36 subscales with higher scores for employed patients compared to the unemployed and those with higher haemoglobin levels. High pre dialysis serum creatinine, dry weight and serum albumin had significant positive correlation with SF-36 scale scores. Elevated liver enzymes and dialysis adequacy had no significant correlation with SF-36 scale scores. A significant negative correlation was present between serum phosphate and PTH on overall HRQOL.
Conclusion:HCV infection impairs HRQOL, in many aspects in hemodialysis patients. Better HRQOL is associated with male gender, younger age, employment, higher hemoglobin, higher pre dialysis serum creatinine and higher serum albumin. Prevention of HCV transmission by proper infection control measures reduces the economic burden and complications in hemodialysis.

Keywords: Hemodialysis; Hepatitis C virus; HRQOL; SF-36

Abbreviations

HRQOL: Health-Related Quality of Life; HCV: Hepatitis C Virus; ESRD: End-Stage Renal Disease; QOL: Quality of Life; PF: Physical Functioning; RP: Role-Physical; BP: Bodily Pain; SF: Social Functioning; GH: General Health; RE: Role-Emotional; MH: Mental Health; DOPPS: Dialysis Outcomes and Practice Patterns Study

Introduction

Health-related quality of life (HRQOL) is a multidimensional concept that reflects a patient’s perceived well-being and functioning in physical, psychological and social domains of health [1].End-stage renal disease (ESRD) is a chronic restrictive illness that affects many aspects of patient’s life. Moreover, ESRD has become worldwide public health problem [2] causing a high level of disability in different domains of the patients' lives, leading to impaired quality of life (QoL) [3].Although there have been many advances in the treatment of end- stage renal disease (ESRD), mortality rates for ESRD patients remain several times higher than those of age-matched controls, and patients with ESRD continue to have significant impairments in quality of life (QOL), quality of life is related with morbidity and mortality in hemodialysis patients, and it is suggested that QOL should be considered in the regular monitoring of dialysis patients [4]. Hemodialysis patients infected with HCV often have poor short-term clinical outcome, greater mortality, greater hospitalization rate, more significant protein-energy malnutrition and worse health - related quality of life [5].

The prevalence of HCV infection in patients undergoing dialysis is persistently greater than that in the general population, being endemic in hemodialysis units around the world predominantly in Mediterranean and developing countries of the Middle and Far East [6]. It was well demonstrated that HCV had a negative impact on health-related quality of life (HRQOL). Why quality of life decreases in HCV infected patients is incompletely understood [4]. The aim of this study was is to assess health related quality of life (HRQoL) in hepatitis C Virus (HCV) seropositive hemodialysis Egyptian patients.

Patients and Methods

This study was carried out at dialysis units at Ain Shams University hospitals and National Institute of Nephrology and Urology. Two hundred patients were included in this study.

Patients were divided into 2 groups
Group I: (HCV Ab negative group).Consists of 100 patients with ESRD, undergoing regular hemodialysis of at least 6 months duration, 4 hours each session, three times/week. HD therapy was performed with a low flux biocompatible membrane, using AV fistula and bicarbonate dialysis solution.

Group II: (HCV Ab positive group). Consists of 100 patients with ESRD, under regular hemodialysis of at least 6 months duration, 4 hours each session, three times/week. HD therapy was performed with a low flux biocompatible membrane, using AV fistula and bicarbonate dialysis solution.

Exclusion criteria

  • Age below 18 years or above 60 years.
  • Signs of advanced liver disease (ascites, jaundice, bleeding tendency…etc.).
  • History of other chronic diseases (Ischemic heart disease, chronic pulmonary disease, cerebrovascular disease…etc.).
  • Previous or simultaneous malignancies.
  • Severe anemia (Hemoglobin less than 9 gm/dl).
  • Major surgery in last 6 months.
  • Non cooperative patients.

All patients underwent

  • Thorough medical history and clinical examination including: age, gender, marital status, employment and occupation, social status, etiology of ESRD, duration of dialysis, dialysis dosage, vascular access and dry weight.
  •  B-The data collection for this study was approved by the Ethics Committee and all subjects provided written informed consent before participating in this study.

Laboratory investigations: Blood samples were taken for determination of the following:

    • Hemoglobin, pre dialysis blood urea, serum creatinine.
    • Calcium, phosphorus, parathyroid hormone, ALT, AST, Albumin.
    • Viral markers: HCV Ab, HBs Ag, HIV Ab.
    • Dialysis adequacy as measured by single pool Kt/v
  • Health-related quality of life measurement:

 It was measured through Short Form 36 (questionnaire). SF-36 Questionnaire was filled by all patients, data were analyzed from this questionnaire to determine the QOL for all patients. SF-36 questionnaire is a generic instrument that includes 36 items assessing 8 scales of functioning ability and health well-being of individuals. The 8 multi-item scales are as follows:
(1) Physical Functioning (PF) is a 10-questions scale that captures abilities to deal with the physical requirement of life, such as attending to personal needs, walking, and flexibility. (2) Role-Physical (RP) is a 4 items scale that evaluates the extent to which physical capabilities limit activity. (3) Bodily Pain (BP) is a 2 items scale that evaluates the perceived amount of pain experienced during the most recent 4 weeks and the extent to which that pain interfered with normal work activities. (4) General Health (GH) is a 5 items scale that evaluates general health in terms of personal perception.

(5) Vitality (VT) is a 4 items scale that evaluates feeling of energy and fatigue. (6) Social Functioning (SF) is a 2 items scale that evaluates the extent and amount of time, if any, that physical health or emotional problems interfered with family, friends, and other social interactions during the most recent 4 weeks. (7) Role-Emotional (RE) is 3 items scales that evaluate, the extent, if any, to which emotional factors interfere with work or other activities. (8) Mental Health (MH) is a 5-items scale that evaluates feelings principally of anxiety and depression.

In each dimension the respondent receives a score from 0 to 100. The higher the score, the better the health.
D-SF-36 eight subscales can also be combined into 2 component summary scores, a physical component summary PCS (general health, physical function, role-physical, bodily pain) and a mental component summary MCS (role – emotional, vitality, mental health, and social function) (Table 1).

Regarding clinical and laboratory data:
- The duration of hemodialysis is significantly higher in group 2.
- The dry weight is significantly higher in group 1.
- The hemoglobin level in group 2 is significantly higher than group 1.
- ALT and AST in group 2 is significantly higher than group 1.
- Albumin in group 2 is significantly lower than group 1.
- Kt/v is significantly higher in group 1 (Table 2).

Males showed significant better quality of life than females in the same group with significantly higher scores in the following quality of life domains: physical functioning, role emotional, social functioning, general health, physical component summary and mental component summary (Table 3).

There was significant higher score in role emotional, bodily pains and physical component summary in males than females of this group (Table 4).

Employed patients had significantly better quality of life than unemployed patients in the same group with significantly higher score in physical functioning, vitality, social functioning, general health, physical component Summary and mental component summary (Table 5).

There is no significant difference in quality of life between employed and unemployed patients but there is only significant higher score in physical function in employed patients (Table 6).

In group 1:

  • QOL was affected by age with a significant –ve correlation between age and PF, P=0.05 and a significant +ve correlation between age and MH , P= 0.036.
  • There was also a significant + ve correlation between Hgb level and PF, VT, MH, GH, QoL, PCS and MCS P= 0.034, 0.015, 0.027, 0.002, 0.01, 0.004, and 0.018 respectively.
  • There was also a significant + ve correlation between pre dialysis serum creatinine and PF, MH, GH, QoL, PCS and MCS P= .00, 0.042, 0.001, 0.04, 0.018, and 0.047 respectively.
  • There was no effect of serum albumin, PTH or Kt/v on QOL.

*Correlation is significant at the 0.05 level (2-tailed).
**Correlation is significant at the 0.01 level (2-tailed).
PF: Physical Functioning; RP: Role Physical; RE: Role Emotional; VT: Vitality; MH: Mental Health; SF: Social Functioning; BP: Bodily Pains; GH: General Health; QOL: Quality of Life; PCS: Physical Component Summary; MCS: Mental component summary (Table 7).

**Correlation is significant at the 0.01 level (2-tailed).
PF: Physical Functioning; RP: Role Physical; RE: Role Emotional; VT: Vitality; MH: Mental Health; SF: Social Functioning; BP: Bodily Pains; GH: General Health; QOL: Quality of Life; PCS: Physical Component Summary; MCS: Mental Component Summary (Table 8).

 

HCV Negative

HCV Positive

- Age (years)

42.4+13

43.+10.7

- Gender:

 

 

*Male

38 (38%)

68 (68%)

*Female

62 (62%)

32 (32%)

-Duration of HD (years)

4.24+2.53

7.6+5.69

- Dry weight (kg)

71.82+20

66.16+18.39

Table 1: The demographic characteristics of patients included in the study are shown in the table.

HCVAb

 

N

 

Mean

 

Std. Deviation

Std. Error
Mean

t-test for Equality of Means

t

PValue

Age                                      Negative
Positive

100

100

42.4000

43.0200

13.00660

10.76937

1.30066

1.07694

-.367-

.714

Duration of HD                                      Negative
Positive

100

100

4.2420

7.6000

2.53015

5.69689

.25301

.56969

-5.387-

.000

Dry Weight                                      Negative
Positive

100

100

71.8200

66.1600

20.02896

18.39341

2.00290

1.83934

2.081

.039

Hgb                                      Negative
Positive

100

100

10.2480

10.8060

1.13159

1.43173

.11316

.14317

-3.058-

.003

Urea                                      Negative
Positive

100

100

98.4400

117.4800

30.67270

47.98326

3.06727

4.79833

-3.343-

.001

Creat.                                      Negative
Positive

100

100

10.2320

9.7600

2.61923

2.02978

.26192

.20298

1.424

.156

ALT                                      Negative
Positive

100

100

25.3800

34.4800

4.06955

10.63678

.40695

1.06368

7.990-

.000

AST                                      Negative
Positive

100

100

15.8800

25.9800

3.96775

7.56785

.39677

.75678

-11.820

.000

Albumin                                      Negative
Positive

100

100

3.8800

3.4720

.32035

.24291

.03204

.02429

10.148

.000

Ca                                      Negative
Positive

100

100

8.8120

8.9160

.63394

.52852

.06339

.05285

-1.260-

.209

Phos.                                      Negative
Positive

100

100

5.8940

5.6880

.92887

1.04517

.09289

.10452

1.473

.142

PTH                                      Negative
Positive

100

100

492.7000

580.7200

334.48886

309.94167

33.44889

30.99417

-1.930-

.055

Kt/v                                      Negative
Positive

100

100

1.1255

1.0623

.19089

.22500

.01919

.02250

2.134

.034

Physical Functioning                                      Negative
Positive

100

100

55.5000

56.1000

22.47895

21.06483

2.24789

2.10648

-.195-

.846

Role Physical                                      Negative

Positive

100

100

40.0000

27.5000

42.93523

41.51488

4.29352

4.15149

2.093

.038

Role Emotional                                      Negative
Positive

100

100

53.3320

22.6660

43.93639

38.16150

4.39364

3.81615

5.269

.000

Vitality                                      Negative
Positive

100

100

46.8000

40.5000

14.69419

19.36492

1.46942

1.93649

2.592

.010

Mental Health                                      Negative
Positive

100

100

52.2400

45.9200

17.23347

15.51258

1.72335

1.55126

2.726

.007

Social Functioning                                      Negative

Positive

100

100

58.0000

51.0000

24.45879

22.59101

2.44588

2.25910

2.102

.037

Bodily Pains                                      Negative

Positive

100

100

49.1500

44.3500

26.24001

27.71523

2.62400

2.77152

1.258

.210

General Health                                      Negative

Positive

100

100

39.5000

37.2000

17.47292

18.91395

1.74729

1.89139

.893

.373

Quality Of Life                                      Negative

Positive

100

100

50.2524

40.9759

16.95088

17.94395

1.69509

1.79439

3.758

.000

Physical Component                                      Negative
Summary
Positive

100

100

46.1300

41.1320

17.15638

19.46517

1.71564

1.94652

1.926

.056

Physical Component                                      Negative
Summary
Positive

100

100

46.1300

41.1320

17.15638

19.46517

1.71564

1.94652

1.926

.056

Table 2: Comparative study between the two patients groups regarding clinical data, laboratory investigations and quality of life parameters

 

Sex

N

Mean

Std. Deviation

t

Sig. (2-Tailed)

Physical Functioning

Male

38

64.7368

21.77736

3.382

.001

Female

62

49.8387

21.13516

Role Physical

Male

38

50.0000

44.26578

1.845

.068

Female

62

33.8710

41.26503

Role Emotional

Male

38

64.9116

45.81417

2.098

.038

Female

62

46.2348

41.53436

Vitality

Male

38

50.5263

16.99720

1.882

.065

Female

62

44.5161

12.69793

Mental Health

Male

38

56.2105

17.17188

1.825

.071

Female

62

49.8065

16.95011

Social Functioning

Male

38

69.0789

21.50127

3.776

.000

Female

62

51.2097

23.81513

Bodily Pains

Male

38

51.9737

28.54085

.841

.402

Female

62

47.4194

24.80650

General Health

Male

38

47.6316

20.22632

3.546

.001

Female

62

34.5161

13.45026

Quality Of Life

Male

38

57.4430

18.73290

3.282

.002

Female

62

45.8453

14.19582

Physical Component Summary

Male

38

52.9737

19.52509

3.033

.004

Female

62

41.9355

14.12110

Mental component Summary

Male

38

58.1211

16.72149

4.264

.000

Female

62

45.2581

13.22258

Table 3: Comparative study between males and females of HCV negative group regarding quality of life scores.

 

Sex

N

Mean

Std. Deviation

t

Sig. (2-Tailed)

Physical Functioning

Male

68

58.5294

19.90760

1.697

.093

Female

32

50.9375

22.80483

Role Physical

Male

68

31.6176

43.32661

1.547

.126

Female

32

18.7500

36.47801

Role Emotional

Male

68

28.4306

41.63462

2.638

 

Female

32

10.4163

26.00968

.010

Vitality

Male

68

42.0588

21.12923

1.335

.186

Female

32

37.1875

14.69790

Mental Health

Male

68

47.0588

16.17985

1.071

.287

Female

32

43.5000

13.92144

Social Functioning

Male

68

51.8382

22.47145

.539

.591

Female

32

49.2188

23.10074

Bodily Pains

Male

68

48.6765

29.04728

2.552

.013

Female

32

35.1563

22.38715

General Health

Male

68

38.5294

18.98662

1.025

.308

Female

32

34.3750

18.74059

Quality Of Life

Male

68

43.1023

19.44459

1.987

.050

Female

32

36.4571

13.42059

Physical Component Summary

Male

68

43.8824

21.04049

2.402

.018

Female

32

35.2875

14.18981

Mental component Summary

Male

68

41.5861

19.60801

1.706

.092

Table 4:Comparative study between males and females of HCV positive group regarding quality of life scores.

 

N

Mean

Std. Deviation

Minimum

Maximum

PValue

Physical Functioning

Employed

24

72.5000

21.61923

20.00

100.00

 

Unemployed

76

50.0000

20.30588

5.00

85.00

.000

Total

100

55.5000

22.47895

5.00

100.00

 

Role Physical

Employed

24

45.8333

45.24491

.00

100.00

 

Unemployed

76

36.4865

41.62561

.00

100.00

.088

Total

100

40.0000

42.93523

.00

100.00

 

Role Emotional

Employed

24

55.5550

48.81844

.00

100.00

 

Unemployed

76

51.3497

42.44747

.00

100.00

.294

Total

100

53.3320

43.93639

.00

100.00

 

Vitality

Employed

24

55.8333

17.91688

25.00

80.00

 

Unemployed

76

44.0541

12.48768

25.00

70.00

.002

Total

100

46.8000

14.69419

25.00

80.00

 

Mental Health

Employed

24

58.6667

18.60030

24.00

84.00

 

Unemployed

76

49.9459

16.52884

16.00

92.00

.079

Total

100

52.2400

17.23347

16.00

92.00

 

Social Functioning

Employed

24

69.7917

23.57823

25.00

100.00

 

Unemployed

76

54.0541

23.96024

12.50

100.00

.021

Total

100

58.0000

24.45879

12.50

100.00

 

Bodily Pains

Employed

24

56.8750

31.00009

.00

100.00

 

Unemployed

76

47.3649

24.26273

10.00

100.00

.106

Total

100

49.1500

26.24001

.00

100.00

 

General Health

Employed

24

55.0000

22.16539

15.00

90.00

 

Unemployed

76

34.7297

12.43867

5.00

60.00

.000

Total

100

39.5000

17.47292

5.00

90.00

 

Quality Of Life

Employed

24

59.1861

21.90983

30.44

88.39

 

Unemployed

76

47.0766

14.10860

25.44

69.50

.006

Total

100

50.2524

16.95088

25.44

88.39

 

Physical Component Summary

Employed

24

57.2083

22.02613

28.00

88.00

 

Unemployed

76

42.4459

13.85284

20.00

71.50

.001

Total

100

46.1300

17.15638

20.00

88.00

 

Mental

Employed

24

59.6833

18.32825

29.30

84.00

 

component

Unemployed

76

46.8270

13.87055

25.90

73.40

.001

Summary

Total

100

50.1460

15.86200

25.90

84.00

 

Table 5: Comparative study between employed and unemployed patients of HCV negative group regarding quality of life scores.

P Value

Maximum

Minimum

Std. Deviation

Mean

N

 

 

95.00

35.00

19.24604

64.1176

34

Employed

Physical Functioning

.006

95.00

20.00

20.90047

51.9697

66

Unemployed

 

95.00

20.00

21.06483

56.1000

100

Total

 

100.00

.00

40.10903

29.4118

34

Employed

Role Physical

.743

100.00

.00

42.48954

26.5152

66

Unemployed

 

100.00

.00

41.51488

27.5000

100

Total

 

100.00

.00

40.00317

29.4106

34

Employed

Role Emotional

.206

100.00

.00

37.00768

19.1915

66

Unemployed

 

100.00

.00

38.16150

22.6660

100

Total

 

80.00

15.00

16.60058

43.2353

34

Employed

Vitality

.313

90.00

.00

20.62316

39.0909

66

Unemployed

 

90.00

.00

19.36492

40.5000

100

Total

 

80.00

28.00

14.65662

49.1765

34

Employed

Mental Health

.133

84.00

8.00

15.78126

44.2424

66

Unemployed

 

84.00

8.00

15.51258

45.9200

100

Total

 

100.00

12.50

25.46362

52.2059

34

Employed

Social Functioning

.704

100.00

.00

21.14166

50.3788

66

Unemployed

 

100.00

.00

22.59101

51.0000

100

Total

 

100.00

.00

32.21889

47.0588

34

Employed

Bodily Pains

.486

90.00

.00

25.24080

42.9545

66

Unemployed

 

100.00

.00

27.71523

44.3500

100

Total

 

75.00

5.00

21.10157

41.7647

34

Employed

General Health

.083

70.00

.00

17.38633

34.8485

66

Unemployed

 

75.00

.00

18.91395

37.2000

100

Total

 

82.22

17.06

19.61574

43.8475

34

Employed

Quality Of Life

.253

85.44

11.72

16.98601

39.4965

66

Unemployed

 

85.44

11.72

17.94395

40.9759

100

Total

 

87.00

14.00

21.42325

45.1176

34

Employed

Physical Component Summary

.143

87.00

13.00

18.20672

39.0788

66

Unemployed

 

87.00

13.00

19.46517

41.1320

100

Total

 

84.00

18.20

18.81543

43.9151

34

Employed

Mental component Summary

.097

86.80

12.20

17.52176

37.5507

66

Unemployed

 

86.80

12.20

18.13179

39.7146

100

Total

Table 6: Comparative study between employed and unemployed patients in HCV positive group.

MCS

PCS

QoL

GH

BP

SF

MH

VT

RE

RP

PF

 

.115

-.032

.039

.020

-.109

.168

.210*

.093

-.013

.069

-.197

Pearson Correlation

Age

.254

.755

.698

.847

.280

.095

.036

.358

.898

.497

.050

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.252*

.140

.183

.000

-.157

.254*

.019

.128

.249*

.259**

.132

Pearson Correlation

Duration of HD

.012

.166

.069

.998

.119

.011

.851

.206

.012

.009

.189

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.176

.002

.104

.133

-.007

.345**

.241*

.112

-.076

-.109

.051

Pearson Correlation

Dry Weight

.079

.984

.304

.188

.942

.000

.016

.267

.451

.280

.613

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.236*

.287**

.257**

.307**

.095

.088

.222*

.244*

.096

.188

.213*

Pearson Correlation

Hgb

.018

.004

.010

.002

.349

.383

.027

.015

.344

.061

.034

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.073

.155

.120

.097

.015

-.082

.076

.141

.086

.048

.285**

Pearson Correlation

Urea

.473

.124

.235

.339

.885

.416

.451

.162

.393

.636

.004

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.199*

.236*

.206*

.315**

.082

.119

.204*

.294**

.019

-.090

.537**

Pearson Correlation

Creat

.047

.018

.040

.001

.417

.237

.042

.003

.851

.373

.000

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.019

.099

.053

.152

.072

-.023

-.080

-.067

.032

.123

-.024

Pearson Correlation

ALT

.854

.328

.599

.131

.476

.818

.431

.506

.749

.222

.811

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

-.124

-.084

-.120

.014

.002

-.081

-.085

-.098

-.129

-.069

-.140

Pearson Correlation

AST

.218

.406

.233

.892

.985

.423

.402

.330

.201

.493

.166

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.024

-.034

-.081

.195

-.127

.088

-.056

.008

-.077

-.129

.098

Pearson Correlation

Albumin

.810

.734

.425

.052

.208

.382

.579

.939

.449

.203

.331

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

Table 7: Correlations between QoL domains and clinical, laboratory data in both groups.

MCS

PCS

QoL

GH

BP

SF

MH

VT

RE

RP

PF

 

.066

.053

.084

.065

.074

.092

.073

.018

.068

.128

-.180

Pearson Correlation

Age

.517

.603

.406

.519

.462

.361

.472

.860

.503

.206

.073

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.063

-.076

-.033

-.044

-.207-*

.011

-.021

-.099

.175

.032

-.010

Pearson Correlation

Duration of HD

.530

.454

.743

.665

.039

.914

.833

.325

.081

.752

.923

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.134

.134

.126

.196

-.015

.121

.068

.213*

.041

.154

-.038

Pearson Correlation

Dry Weight

.184

.185

.212

.050

.879

.230

.501

.033

.687

.125

.707

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.476**

.488**

.506**

.225*

.321**

.296**

.471**

.305**

.499**

.493**

.380**

Pearson Correlation

Hb

.000

.000

.000

.024

.001

.003

.000

.002

.000

.000

.000

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.365**

.302**

.320**

.248*

.210*

.316**

.068

.286**

.381**

.331**

-.021

Pearson Correlation

Urea

.000

.002

.001

.013

.036

.001

.502

.004

.000

.001

.839

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.020

.075

.018

.162

.136

-.077

.015

.094

-.040

-.017

-.029

Pearson Correlation

Creat

.845

.458

.856

.107

.178

.444

.884

.355

.690

.864

.775

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.090

.164

.120

.181

.269**

-.065

.081

-.011

.116

.100

.056

Pearson Correlation

ALT

.372

.102

.235

.072

.007

.520

.423

.910

.252

.321

.578

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.067

.137

.072

.223*

.174

-.139

.107

.009

.046

.066

.065

Pearson Correlation

AST

.511

.174

.476

.026

.083

.169

.289

.929

.650

.514

.518

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

.313**

.226*

.278**

.025

.012

.272**

.104

.269**

.345**

.297**

.174

Pearson Correlation

Albumin

.002

.023

.005

.809

.904

.006

.301

.007

.000

.003

.084

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

-.049

-.006

-.012

.004

.079

-.107

-.040

.007

-.008

.017

-.173

Pearson Correlation

Ca

.631

.956

.907

.972

.433

.289

.691

.944

.936

.870

.085

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

-.207-*

-.186

-.219-*

-.064

-.023

-.180

-.201-*

-.156

-.159

-.206-*

-.221-*

Pearson Correlation

Phos.

.038

.063

.029

.530

.817

.073

.045

.120

.115

.039

.027

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

-.135

-.113

-.162

.019

-.003

-.154

-.137

-.247-*

-.041

-.008

-.293-**

Pearson Correlation

PTH

.182

.262

.108

.852

.973

.126

.174

.013

.689

.938

.003

Sig. (2-tailed)

 

100

100

100

100

100

100

100

100

100

100

100

N

 

.115

.095

.114

-.017

-.038

.193

-.072

.048

.128

.130

.202*

Pearson Correlation

Kt/v

.255

.347

.258

.864

.708

.055

.478

.636

.204

.196

.043

Sig. (2-tailed)

100

100

100

100

100

100

100

100

100

100

100

N

Table 8: *Correlation is significant at the 0.05 level (2-tailed).

In group 2

  • QOL was not affected by age.
  • QOL was affected by dry weight with a significant +ve correlation between dry weight and VT and GH P=0.033 and 0.05 respectively.
  • There was a significant + ve correlation between Hgb level and PF, RP, RE, VT, MH, BP, PCS and MCS P=0.0, 0.0, 0.0, 0.0, 0.001, 0.024 respectively.
  • There was a significant + ve correlation between serum albumin level and PCS P=0.023.
  • There was a significant - ve correlation between phosphate PF, RP, MH and MCS.P=0.027, 0.039, 0.045 and 0.038 respectively.
  • QOL was affected by PTH with a significant -ve correlation between PTH and VT P=0.013.
  • QOL was not affected by pre dialysis serum creatinine.
  • Liver enzymes ALT and AST were higher in this group than HCV negative group but, they had no significant correlation with QoL.

Discussion

Quality of life is one of the important indicators of the effects of medical treatment. Hemodialysis patients experience various problems that may adversely influence their quality of life. Hepatitis C virus (HCV) infection is also an important problem in hemodialysis patients. This is the most important comorbid disease that can affect their quality of life [7].A variety of instruments for measuring HRQOL exist, including those that are “generic” and those that are “disease- targeted” [8]. The tool most commonly used to study HRQOL in people with renal disease is the SF-36 [9].

In this study, SF-36 Questionnaire was used to compare and study QOL among both HCV Ab negative and positive hemodialysis patients and the effect of different clinical and laboratory variables on their QOL. Our study showed that HCV seropositive hemodialysis patients had compromised health related quality of life in comparison to HCV seronegative patients which was found in most of SF-36 subscales particularly in role physical, role emotional, vitality, mental health and social functioning subscales and mental component summary.

In group 2, we demonstrated that the majority of the SF-36 subscales were lower in anti- HCV antibody positive HD patients compared with in anti-HCV antibody negative patients except physical functioning subscale which is comparable. In this group QOL was not affected by age, but affected by gender and males were found to have higher scores in role emotional, bodily pains and PCS compared to females. Afsar et al. [4] demonstrated that the majority of the SF-36 subscales were lower in anti- HCV antibody positive HD patients compared with in anti-HCV antibody negative patients, with an independent association between anti-HCV antibody positivity and MCS of SF-36, but not with PCS, which was in agreement with our study.

The exact mechanisms regarding the relationship between anti-HCV seropositive hemodialysis patients and low MCS and depression remain not fully understood. Presence of depressive symptoms might be one of the explanations; both HCV and HD are implicated in an increased prevalence of depression, which negatively impacts HRQOL. It has been shown that HD patients with depression scored lower on all of the 8 SF-36 subscales than patients without depression. Depression may exist as a secondary phenomenon to HCV infection: it may take the form of a reactive depression related to the diagnosis or concerns over long-term health or may be linked to symptoms such as fatigue and cognitive impairment [8]. In HCV seronegative group, we found that male gender and younger age were associated with better quality of life with a significant negative correlation between age and physical functioning. Also, we found that males had higher scores in majority of the SF-36 subscales and overall QoL.

Anca Seica et al. [10] found that age had a significant impact on health related QoL especially physical component summary of the SF36, but not on MCS and that women had lower QoL scores than men(which was in agreement with our study). Women on hemodialysis generally have lower QoL than men due to factors other than clinical ones including difficulty coping with kidney disease, more susceptibility to anaemia, anxiety and depressive symptoms with an association between psychological and social factors. In addition, women on hemodialysis usually continue performing their traditional roles of home making and child caring, unlike men, they cannot circumvent and thus are exposed to higher levels of physical and mental stress, resulting in lower QoL than men [11].

In our study, we found that employed patients had significantly better quality of life than unemployed patients with significantly higher scores in physical functioning, vitality, social functioning, general health, PCS and MCS. In 2007 analysis of baseline data of 9,526 hemodialysis patients from 7 countries enrolled in phase I of the Dialysis Outcomes and Practice Patterns Study (DOPPS) [12] found that being unemployed (compared with employed) was independently and significantly associated with lower scores in all eight SF-36 scales, with larger differences being observed for role-emotional and role-physical, which was in agreement with our study.

In our study, there was a positive correlation between haemoglobin levels and the following SF-36 subscales: physical functioning, vitality, mental health, general health, physical component summary and mental component summary. In agreement with our study, Afsar et al. [4] found positive correlation between haemoglobin levels and the following SF-36 subscales: physical functioning, role-physical limitation, bodily pain, general health perception, vitality, social functioning, role emotional and mental health subscales, PCS and MCS.

Moreover, interestingly, we found that haemoglobin levels were significantly higher in HCV seropositive patients than HCV seronegative which may be responsible for comparable physical functioning subscale between two groups. Similarly, Khurana et al. [13] documented that hepatitis C patients tend to have higher baseline haemoglobin and decreased need for EPO therapy on dialysis. The possible explanation for these findings may be the release of hepatic EPO because of chronic hepatic inflammation secondary to HCV infection.

As in group 1, there was a significant positive correlation between haemoglobin level and the following SF-36 subscales: physical functioning, role physical, role emotional, vitality, mental health and bodily pains, and PCS and MCS, which was in agreement with Fabrizi et al. [8]. In group 1 (and not in group 2), a significant positive correlation between pre dialysis serum creatinine and physical functioning, mental health, general health subscales, PCS and MCS. Feroze et al. [14] showed that better QoL was associated with higher pre dialysis serum creatinine which was surrogate for larger muscle mass and/or greater meat intake. Similarly, Fabrizi et al. [8] reported direct relationship between serum creatinine and SF-36 scale scores in hemodialysis population and the largest correlations were recorded in the general health, mental health, and bodily pain subscales.

Also, Spiegel et al. [15] found that patients with low creatinine had a significantly lower adjusted SF-36 PCS score versus patients with higher levels of serum creatinine. In our study, there was no significant relation between dialysis adequacy, as measured by Kt/V and QOL. Our findings were similar to the findings of Fabrizi et al. [8] and Spiegel et al. [15]. In contrast, Asfar et al. [4] found that Kt/V was only correlated with the mental health subscale.

In our study, we found that QOL was affected by dry weight with a significant positive correlation between dry weight and vitality and general health subscales. Spiegel et al. [15] documented highly significant independent correlations between dry weight and both PCS and MCS scores of the SF-36, similar to results of our study. Also, Kalantar- Zadeh et al. [16] documented highly significant independent correlations between BMI and both PCS and MCS scores of the SF-36, which was in agreement with our study. In our study, there was a significant positive correlation between serum albumin level and role physical, role emotional, vitality, social functioning subscales, PCS and MCS.

Afsar et al. [4] found that serum albumin was positively correlated with role physical limitation, bodily pain, general health perception, vitality, role emotional and mental health subscales, PCS and MCS, but other subscales were not related to the serum albumin level. Feroze et al. [14] suggested that better QoL was associated with higher serum albumin levels, which were surrogates for greater meat intake and for higher visceral protein stores. In this study liver enzymes ALT and AST were significantly higher in HCV seropositive patients than seronegative patients but, they had no significant correlation with SF-36 subscales. In Afsar et al. [4] found that HRQOL was not related to liver enzymes ALT, AST in HCV-infected HD patients, which was in agreement with our study.

In our study there was a significant negative correlation between phosphate and overall quality of life, physical functioning, role physical and mental health subscales and mental component. Also we found that QOL was affected by parathyroid hormone with a significant negative correlation between PTH and physical functioning and vitality subscales of SF-36. In contrast to us, Fabrizi et al. [8] reported that mineral metabolism (such as parathyroid hormone, calcium/phosphorus levels) had small effect sizes and correlations with HRQOL. Similarly, Tanaka et al. [17] found a non-significant difference in mental health scores in patients with high versus low PTH levels.

Conclusion

HCV infection impairs quality of life, in many mental aspects in hemodialysis patients particularly in role physical, role emotional, vitality, mental health and social functioning subscales and mental component summary. Better quality of life is associated with male gender, younger age, employment, higher hemoglobin, higher pre dialysis serum creatinine and higher serum albumin.

Recommendations

  1. Improving Hemoglobin level in hemodialysis patients which is associated with better quality of life.
  2. Improving nutritional status and increasing body mass index.
  3. Encouraging patients to join employments.
  4. Prevention of hepatitis C transmission by proper Infection control measures reduces the economic burden and complications in hemodialysis.

References

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